267458 Death on the Street: 12 Year Observational Study of Mortality of a “Rough Sleeper” Population in Boston, MA 2000-2011

Tuesday, October 30, 2012 : 11:10 AM - 11:30 AM

James O'Connell III, MD , Boston Health Care for the Homeless Program, Boston, MA
Jill Roncarati, PA-C, MPH , Dept. of Society, Human Development, & Health, Harvard School of Public Health, Boston, MA
A dearth of literature exists to document deaths among street dwellers. This study assesses the 12-year mortality in a population of rough sleepers followed by Boston Health Care for the Homeless Program's (BHCHP's) Street Team, a multidisciplinary team model of care offering health care services on the streets. The Street Team works with outreach teams, conducts hospital-based clinics and inpatient care. Access is available from street to detoxification units and BHCHP's 104-bed medical respite program. A 12-year prospective study to determine death among a cohort of 119 high-risk individuals identified from >800 persons in January 2000. Criteria for inclusion are &ge 18 years and living on street for &ge 6 consecutive months and &ge 1 of seven risk factors. The cohort does not differ demographically from 7000 sheltered homeless persons. Eight-eight percent of cohort suffers from tri-morbidity of medical illness, mental illness, and substance abuse. Contact data is recorded at weekly team meetings. After 12 years, 59 are deceased. Deaths occurred equally in all seasons. The most common cause of death was cancer. One death was from hypothermia. All decedents were seen in emergency rooms or hospitals in month before death and over half who died were admitted to a detoxification unit in month prior to death. Mortality is high among those sleeping rough. The streets are equally dangerous during warm and cold months. This cohort had high medical utilization. Improvement in identification of those at risk and improved coordination of care may help reduce mortality in this vulnerable population.

Learning Areas:
Administer health education strategies, interventions and programs
Basic medical science applied in public health
Chronic disease management and prevention
Clinical medicine applied in public health
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the most common casues of death in a "rough sleeper" popuation in Boston

Keywords: Homeless Health Care, Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working on prospective cohort study at Boston Health Care for the Homeless Program for 12 years and have been using data obtained from the study for part of my dissertation at Harvard School of Public Health. During the course of the 12 years of the project, I have obtained my MPH degree as well. As a result, I feel I am fully qualified to present on mortality of rough sleepers in Boston.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.